On the Job in the ICU
July 30, 2020
Photo by Navy Medicine
As medical interns step into their new roles as doctors, one resident gives us a window into her experiences in the COVID ICU.
Listen to the full episode below or scroll down for the transcript and more information.
Click here for more of our coronavirus coverage.
NOTE: An additional post-script was added to the end of this story when it re-aired on Dec. 10, 2020.
Tamar Pounardjian: Good morning it’s July 4th. It’s currently 5:47 AM. I’m about to walk into work. It’s a beautiful day to save lives. Just kidding. It’s from Grey’s Anatomy.
Dan Gorenstein: Jokes can be hard to come by these days for Dr. Tamar Pounardjian.
We initially spoke to the newly minted resident on June 24, hours before she walked into the hospital for her first shift as a doctor.
She’s spent her first month working on a COVID ICU unit in Rhode Island Hospital in Providence.
Studying medicine for years, working in hospice, even time with patients as a student were poor substitutes for what Tamar has encountered these past four weeks.
TP: It’s a very different experience to hear it and then to actually experience it and go through it.
DG: From the Annenberg Studio at the University of Pennsylvania, I’m Dan Gorenstein and this is Tradeoffs.
DG: In June, Tamar took a road trip — 650 miles from Cleveland to Providence — on her way to life as a doctor. She listened to medical podcasts.
Sfx: Podcast clip
DG: A playlist from a friend.
Sfx: Soften the Blow by Xavier Rudd
DG: And imagined her first moments in the ICU, being responsible for patients’ health.
Now a month in, instead of 650 miles, her world is contained in one — the stretch between the hospital for 15-hour ICU shifts and home to shower, sleep, eat.
TP: Hello. I’m just leaving my first day shift.
TP: I’m on day two. I’ve worked 26 hours in the last 48 hours.
TP: It’s 8:36. Only 15.5 hours today.
TP: Today is, I think Thursday. Just woke up from my night shift. It’s like it’s four o’clock now.
DG: Long hours, and loud sounds.
Whatever time she shows up, Tamar faces a world of noise — the drum of ventilators pumping oxygen, phones ringing, the AC whirring — punctuated by one distinct alarm: a patient coding.
TP: One weekend, we had like two or three COVID patients pass away. And then, earlier that week, another one had passed away.
DG: As of late July 2020, more than 150,000 people have died from COVID in the U.S.
Because of the pandemic, the U.S. is on track to see many more ICU deaths then normal.
And a lot of people there will die alone.
To control the virus’ spread, hospitals have imposed strict limits on friends and loved ones. Some have banned visits entirely.
Rhode Island Hospital gives two family members 30 minutes, one time, forcing people into an agonizing decision.
TP: Do they come to visit her prior to her passing away or when she does actually pass away?
DG: The policy extends to men and women who are dying from non-COVID conditions too, laying in their beds, distraught, frantic with grief.
More sounds — ones that have lodged into Tamar’s mind.
TP: Listening to that young guy crying all night because he was alone, it was just so hard. He was so young. And I called his aunt. She just said, you know, put him on the phone and maybe hearing my voice will calm him down.
There’s another older gentleman. I sat with him for a little bit. I told him to try to get some sleep. He said, I don’t want to sleep. I know I’m not going to make it. And I want to live as much life as I have left. He’s living his last moments alone. And I just feel like we’re just a Band-Aid.
DG: The day Tamar started her job, she told us she wanted to be a doctor for one simple reason.
TP: End of life, dealing with death, it’s where the meat of life is. And it was in these kind of moments that I wanted to have for the rest of my life.
DG: She’s certainly had those moments. And sometimes it’s been too much.
So Tamar tries to balance these lonely last moments with relief, even a little joy.
TP: We had a COVID patient who had recovered from COVID and he came back because he had a necrotizing pneumonia in his lung and he was coughing up like liters full of blood. He literally described the water bottle of blood.
At one point it got really bad and he had to get intubated. Yesterday he got discharged. Every time every COVID patient gets discharged, they play the Rocky song and like, he’s just this really cute Hispanic man. And he started dancing to it. It was so, it was so awesome.
DG: The literature is robust — intern year is hell. The senior doctors know it, so do the residents.
TP: Right now I’m just tired. And every single friend that I say this to that I like. Yeah, this sounds just like residency. You know my experience is not unique.
DG: Research shows about three in 10 residents will experience depression during this training — four times the general population.
Add the heightened stress and growing death toll from a global pandemic, Tamar and the other 38,000 interns across the U.S. face a great burden.
TP: Everyone has said, you just get used to it. Like, don’t worry, it’s hard right now. But, you know, your body adjusts. You get used to it. And I’m like, I don’t want to adjust to this, like I don’t want to get used to this.
DG: But entering the third and fourth week in the ICU, Tamar’s new-doctor jitters are fading. She’s jumping into action when she needs to, like after meeting a recent COVID patient.
TP: She just got Ativan, she’s on Precedex, she’s on this. And I was trying to think through what could be happening.
DG: Tamar ran through a quick mental checklist.
Her intuition kicked in. She saw the patient needed help breathing, and realized the ventilator settings needed to be adjusted.
TP: I, for the first time, made an independent decision.
DG: And the patient’s breathing settled down.
A small medical moment, maybe, but for Tamar, it signalled: she’s getting the hang of this.
DG: As Tamar gains confidence, and gets more exhausted by the day, life at work keeps changing.
She’s just wrapped up her ICU rotation, and moved to neurology.
Before she left, Tamar had gotten a glimpse of what life as a physician was like without COVID all around her.
TP: When we didn’t have COVID patients, I just felt so relaxed. And it just didn’t seem as hard.
DG: Like someone had let all the toxic air out of the room.
TP: When we do have COVID patients, I feel like I just feel a lot more tense about everything.
DG: The heaviness from COVID is real and it’s scary for Tamar, and there’s a good chance she’ll see a second wave later in the fall.
Then she remembers the man who walked out of the unit to the Rocky theme
And she thinks to herself, this is the right job for me.
Post-script, Dec. 10, 2020
DG: We checked in with Tamar again on Dec. 4, six months into her residency.
TP: A lot has happened since. (laughter)
DG: She looks exhausted, sounds exhausted, and was in the middle of a heavy hematology oncology rotation.
TP: These patients have cancer and are already dealing with the side effects of their treatments. And then they have COVID, and you watch them suffering.
DG: The stats speak for themselves — more than 200,000 new COVID cases a day and more than 2,000 deaths.
Tamar struggles to square the people who call this pandemic a hoax — the people who refuse to wear a mask — with what she’s seeing.
TP: It’s really frustrating. I have to ignore the rest of the world and what they’re doing because it’s really frustrating to watch.
DG: The day I caught up with Tamar was her first one off in 10 days.
She’d just slept 15 hours the night before.
But no matter how difficult these days are, Tamar says she’s really glad she gets to be a doctor in this moment.
I’m Dan Gorenstein, this is Tradeoffs.
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Select Research and Reports on Integrated Primary Care:
Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US (Shruti Gupta, Salim S. Hayek, Wei Wang, et al; JAMA Internal Medicine; 07/15/2020)
Prevalence of Depression and Depressive Symptoms Among Resident Physicians (Douglas A. Mata, Marco A. Ramos, Narinder Bansal; JAMA; 12/08/2015)
Doctors In Training Learn Hard Lessons During The Pandemic (Will Stone; NPR; 05/18/2020)
Residency in a pandemic: How COVID-19 is affecting trainees (Brendan Murphy; AAMC; 04/01/2020)
Ensuring and Sustaining a Pandemic Workforce (Erin P. Fraher, Patricia Pittman, Bianca K. Frogner, et al; New England Journal of Medicine; 06/04/2020)
Tamar Pounardjian, MD, internal medicine resident at Brown University in Providence, Rhode Island
The Tradeoffs theme song was composed by Ty Citerman, with additional music from Xavier Rudd and Blue Dot Sessions.
This episode was produced by Victoria Stern and mixed by Andrew Parrella.
Additional thanks to:
Colleen O’Neil, Amy Engler, Holland Kaplan, Vishal Khetpal, David Leaf, the Tradeoffs Advisory Board…
…and our stellar staff!